Sunday Morning (61): From Infection to Inflammation
This morning I looked at my medication cabinet, from where I run my little home pharmacy.
Suddenly I noticed a shift. The left section of the closet where I keep my anti-inflammation drugs, had advanced up to the middle of one shelf. And complementary, the right section where my antibiotics (anti- infection) drugs reside, has receded down to the middle of this shelf. How fascinating!
I clearly remember times where I stored and regularly ordered and used many types of antibiotics. Simple antibiotics, like doxycycline ad macrolides, to be used continuously for keeping the bugs compliant. More heavy antibiotics, to be used at times of exacerbation, to be used to kill the bugs when not compliant any more. Fluoroquinolones (like Ciproxin), amoxicillin with clavulanic acid (Augmentin), flucloxacillin (Floxapen), cotrimoxazole (Bactrim). At times I nebulized tobramycin or other inhalable antibiotics. And even occasionally I needed IV antibiotics, the real poisonous stuff like piperacillin/tazobactam (Piptazo/Tazocin), Cephalosporines (ceftazidime – Fortum), or meropenem (Meronem/Merem). There was even a difficult period where I needed an IV every two months.
And in those times, I hardly used any anti inflammatory drugs, only beclomethasone for my nose to prevent polyps from growing back after many ENT surgeries.
But times changed, and the notion increased that infection and inflammation are two sides of the same coin, so one cannot just pull on one string, but needs to address both sides of the equation. After all, infection is just the start of a cycle, and it is mostly the inflammation that causes us to experience the signs of it; inflamed tissue is also more susceptible for (re) infection, so this is a vicious cycle that needs to be addressed at both entrances of the process. Enter Zen from there.
In CF, it is often the (innate) inflammation where the problems starts, which attracts bugs to start a party of infections, which increases inflammation etcetera.
I began to inhale steroids as well, Becotide or Seretide. I started using a small dose of oral prednisone daily, which also improved my energy by elevating the blood sugar mildly. I discovered by accident (literally, I broke some ribs and needed a painkiller for a couple of months) the strong anti-inflammatory effects of Diclofenac in 2015, which I use daily in a low dose. This enormously decreased my need for antibiotics (no more IV’s since). I discovered that a low dose of levocetirizine (Xyzal – anti histamine) every other day also calmed down my airways noticeably (I have no hay fever by the way, but still it worked). And recently, because of Trikafta, my eyes became slightly inflamed and I upped the doses of levocetirizine (Xyzal) and added anti histamine eye drops to the equation, which helped reasonably well.
All in all, the focus to control the irritation of the airways due to CF shifted from anti-infection drugs (antibiotics) to anti-inflammation drugs considerably. So much so, that presently I don’t use any antibiotics anymore since Kaftrio (trikafta), but the need for anti inflammation is still there or even increased. This also improved the susceptibility of my airways to antibiotics, so when I need them, they work swiftly, even in normal doses for shorter courses of the standard stuff. Since starting Kaftrio in August 2021, for eight months I only had one mild exacerbation (only fever, no airway trouble), which easily receded after taking a two weeks course of Bactrim. This I think is an improvement by all standards. Fortunately, medical science has also seen this development and the number of available anti inflammatory drugs is slowly increasing, and many more are in the pipeline, specifically tailored to the needs of pwCF, where inflammation works in a very peculiar way because of the faulty electrolyte balance in the cells of the body.
What are your thoughts and experiences with this development? Perhaps we can share our expertise, that could be interesting and helpful!
Cheers, have a quiet Sunday,
Ps if we answer to this thread by one reaction per day, we can keep this subject in the picture of this forum and prevent it from being drowned away in the current #31DaysOfCF tsunami (just an observation, not a judgement).
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